Metabolic syndrome and cardiovascular disease after haematopoietic cell transplantation (HCT) in adults: an EBMT cross-sectional non-interventional study

Metabolic syndrome (MetS) is associated with cardiovascular disease in the general population and is also a potential cardiovascular risk factor in survivors of haematopoietic cell transplantation (HCT). We report an EBMT cross-sectional, multi-centre, non-interventional study of 453 adult HCT patients surviving a minimum of 2 years post-transplant attending routine follow-up HCT and/or late effects clinics in 9 centres. The overall prevalence of MetS was 37.5% rising to 53% in patients >50 years of age at follow-up. There were no differences in rates of MetS between autologous and allogeneic HCT survivors, nor any association with graft-versus-host disease (GvHD) or current immunosuppressant therapy. Notably, there was a significantly higher occurrence of cardiovascular events (CVE, defined as cerebrovascular accident, coronary heart disease or peripheral vascular disease) in those with MetS than in those without MetS (26.7% versus 9%, p < 0.001, OR 3.69, 95% CI 2.09–6.54, p < 0.001), and, as expected, MetS and CVE were age-related. Unexpectedly, CVE were associated with occurrence of second malignancy. Screening for and management of MetS should be integrated within routine HCT long-term follow-up care for both allogeneic and autologous HCT survivors. Further research is warranted, including randomised controlled trials of interventional strategies and mechanistic studies of cardiovascular risk in HCT survivors

Tuberculosis reactivation related with ruxolitinib in a patient with primary myelofibrosis

Primary myelofibrosis (PMF) is a clonal stem cell disease, characterized by bone marrow fibrosis. Ruxolitinib is a selective inhibitor of JAK-1 and JAK-2 used to treat PMF. Its mechanism of action is based on the reduction of signal transduction and cytokine levels; including IL-6 and tumor necrosis factor alpha. Increased infection risk related to Ruxolutinib is rarely reported. Here we describe a case of tuberculosis infection ractivation in a female patient treated with Ruxolitinib. During the treatment, she complained of night sweats, weight loss and enlarged mass in the neck. Excisional mass biopsy revealed a necrotizing granulomatous lymphadenitis. QuantiFERON-TB and PPD tests were not able to diagnose the tuberculosis infection. Therapy with Ruxolitinib was interrupted due to possible immunsuppressive effects and the patient was treated with the standard antituberculosis regimen. After six months, the patient's symptoms had resolved and there was no lymphoadenopathy. In conclusion, it is important to assess the risk of tuberculosis activation before Ruxolitinib treatment. In addition, the diagnosis of tuberculosis using QuantiFERON-TB and PPD may be misleading in patients treated with Ruxolutinib

A randomized study comparing the efficacy of three hepatitis B vaccine induction regimens in adult patients with hematological malignancies

Objective: Non-responsiveness to hepatitis B virus (HBV) vaccines is not rare in hemato-oncological patients due to disease-associated or treatment-induced immune suppression. Although different strategies have been employed to improve the response rates, to date there is not an approved schedule for HBV immunization in patients with hematological malignancies. We designed a prospective randomized study to evaluate the efficacy of 3 different induction regimens for HBV vaccination. Materials and Methods: In the standard-dose (SD) group, total vaccine dose delivered was 40 μg and patients were vaccinated with 20 μg at weeks 0 and 4. In the high-dose dose-intensive (HDDI) group, total vaccine dose delivered was 80 μg and patients were vaccinated with 40 μg at weeks 0 and 4. In the high-dose time-intensive (HDTI) group, total vaccine dose delivered was 80 μg and patients were vaccinated with 20 μg at weeks 0, 2, 4, and 6. Results: In a cohort of 114 patients, 38.6% responded to HBV vaccination. The response rate in the SD arm, HDDI arm, and HDTI arm was 26.2%, 29.7%, and 44.4%, respectively (p>0.05). Age was the only variable identified as having a negative impact on response. Conclusion: Short of achieving statistical significance, a higher response rate was observed in the HDTI arm. Therefore, this study supports a high-dose, time-intensive HBV vaccine induction regimen in patients with hematological malignancies who are not on chemotherapy

Frequency of microalbuminuria and its relationship with other atherosclerotic risk factors in nondiabetic hypertensive patients [16]

PubMed: 17513234[No abstract available

Familial Mediterranean fever and ankylosing spondylitis: A case report

Familial Mediterranean fever (FMF) is an inherited disease characterized by recurrent attacks of fever and accompanying peritonitis, pleuritis, arthritis or erysipelas-like skin disease. The relationship between FMF and spondyloarthropathy (SpA) remains controversial. We described a particular case of 36-yr-old male patient with FMF and ankylosing spondylitis with negative HLA-B27. This case had late-onset FMF in spite of homozygote M694V mutation and his typical acute attacks of FMF began many years after the initiation of complaints related to sacroiliitis. There is no general consensus on whether the association of FMF and SpA is only an occasional coincidence or they are clinically and pathologically linked two conditions. Further studies with larger series are required to clarify the relationship between FMF and SpA

Can lansoprazole, amoxicillin, and clarithromycin combination still be used as a first-line therapy for eradication of helicobacter pylori?

PubMed: 16252185Background/aims: To determine H. pylori eradication rate with lansoprazole-amoxicillin-clarithromycin treatment regimen, which is the most frequently used as first-line therapy, in the Kirikkale region. Methods: One hundred and five patients (44 male, 61 female) with H. pylori infection were included in the study. Patients were divided into two groups based on the endoscopic findings: non-ulcer dyspepsia (n=84, 31 male, 53 female) and acute gastric or duodenal ulcer (n=21, 13 male, 8 female) groups. The diagnosis of H. pylori infection was confirmed if both the urease test and histological examination, which were performed on endoscopic biopsies, were positive. Lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg were given twice daily for 14 days to all patients. Endoscopic biopsies were repeated for the evaluation of eradication three months after the treatment. Results: Ninety-six patients completed the study. Eradication rates were found to be 45.8% (44 of 96) in all patients, 42.1% (32 of 76 patients) in the non-ulcer dyspepsia group and 60% (12 of 20 patients) in the gastric or duodenal ulcer group for per protocol analysis, and the difference between non-ulcer dyspepsia and gastric or duodenal ulcer groups was not statistically significant (p=0.208). Conclusions: Lansoprazole-amoxicillin-clarithromycin treatment regimen, the most frequently preferred regimen in H. pylori eradication, is ineffective in our region. The low eradication rates observed with lansoprazole-amoxicillin-clarithromycin, at least in our region, bring into question its use as a first-line therapy. The use of alternative treatment protocols or antibiotic susceptibility test before the treatment may be helpful in achieving successful eradication with first-line therapy

Prevalence of monoclonal B lymphocytosis in first-degree relatives of chronic lymphocytic leukemia patients in Turkey

OBJECTIVE: Monoclonal B lymphocytosis (MBL) is considered to be a precursor state for chronic lymphocytic leukemia (CLL). This study was planned to evaluate the MBL prevalence in first-degree relatives of CLL patients in Turkey, which is considered to be an ethnic and geographic bridge between the Eastern and Western worlds. METHODS: A total of 136 volunteers [median age: 40 (17-77) years; male/female: 60/76] from 61 families were included. Flow cytometry analysis by 4-colour staining was used for MBL diagnosis. RESULTS: MBL was demonstrated in 17 cases (12.5%). A total of 14 cases (10.3%) were classified as CLL-like MBL, while 3 (2.2%) exhibited a non-CLL-like phenotype. The prevalence of MBL was 12.72% in subjects aged less than 40 years, 12.28% in subjects between 40 and 60 years, and 40% in subjects over 60 years, without statistical significance (p>0.05). A total of 115 cases were evaluated for intermarriage, which was observed in 19 cases (16.5%). The prevalence of MBL did not differ based on intermarriage status (p>0.05). CONCLUSION: The current report is the first MBL prevalence study in a Eurasian population that demonstrates a similar distribution pattern of MBL in Anatolian CLL kindreds. Further efforts should be made to refine our understanding of the natural history and clinical outcomes of MBL

Is there any relationship between pulmonary function tests and post-transplant complications of allogeneic hematopoetic stem cell transplantation?

PubMedID: 22653099Aim. Pulmonary function tests (PFT) have an important role in the assessment of pulmonary and nonpulmonary complications of hematopoetic stem cell transplantation (HSCT). In this study the relationship between PFTs and DLCOadj values and the complications of HSCT was investigated. The possible role of iron overload in the deterioration of the PFTs after HSCT was also searched. Methods. One hundred and fifty one patients who had undergone allogeneic HSCT between years 2003 through 2008, and had the records of PFTs prior to and at 1, 3, 6, 9 and 12 months after transplantation were included in the study. Prospectively collected data of these patients were analysed retrospectively. Results. Although no significant difference was identified in other PFT parameters, a significant decrease in DLCOadj was determined after 1st and 3rd months of HSCT. A significant correlation was found between pretransplant DLCOadj value 600 ng/mL were the independent risk factors for pretransplant DLCOadj <%70 (OR: 0.970, %95 CI: 0.941-0.999 and OR: 2.355, %95 CI: 1.058-5.241 respectively). Conclusion. Although a significant correlation exists between pretransplant DLCOadj values and post-transplant SOS development, pretransplant DLCOadj was not an independent predictor of SOS. Increased serum ferritin levels were common both for pretransplant DLCO decrease and post-transplant SOS development. Iron induced endothelial damage may be the common pathophysiologic mechanism causing lung and liver vulnerability, and DLCOadj may be a non-invasive method of demonstrating this vulnerability